Mauch P, Goodman R, Hellman S
Cancer. 1978 Sep;42(3):1039-45. doi: 10.1002/1097-0142(197809)42:3<1039::aid-cncr2820420302>3.0.co;2-r.
Between April 1969, and December 1974, 111 consecutive surgically staged I A and II A patients with supradiaphragmatic Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Patients received 3600--4400 rad to mantle and para-aortic--splenic pedicle regions. Median follow-up was 56 months (30--96). Fourteen patients developed relapsing Hodgkin's disease and three patients died of possible treatment-related causes, two with acute myocardial infarctions and one with radiation pneumonitis. Patients with mediastinal enlargement greater than one third of the chest diameter have a significantly higher risk (p less than 0.01) of developing relapse (9 of 18) than patients with lesser or no mediastinal disease (5 of 93). Of the 18 patients with large mediastinal disease, six relapsed in the mediastinum and two in the lung. There continue to be no pelvic extensions in the entire group. There is a 92% relapse-free and 97% overall survival in the 93 patients without extensive mediastinal disease. We continue to recommend mantle and para-aortic--splenic pedicle irradiation for these patients. In view of the large number of relapses in patients with extensive mediastinal disease, we are now treating this subgroup of patients with MOPP chemotherapy in addition to mantle and para-aortic irradiation.
1969年4月至1974年12月期间，连续111例经手术分期为ⅠA和ⅡA期的膈上型霍奇金病患者在联合放射治疗中心接受了治疗。患者接受3600 - 4400拉德的斗篷野及腹主动脉旁-脾蒂区照射。中位随访时间为56个月（30 - 96个月）。14例患者发生霍奇金病复发，3例患者可能因治疗相关原因死亡，2例死于急性心肌梗死，1例死于放射性肺炎。纵隔增宽超过胸腔直径三分之一的患者发生复发的风险（18例中有9例）显著高于纵隔病变较轻或无纵隔病变的患者（93例中有5例）（p<0.01）。在18例纵隔病变较大的患者中，6例在纵隔复发，2例在肺部复发。全组患者均无盆腔转移。93例无广泛纵隔病变的患者无复发生存率为92%，总生存率为97%。我们继续推荐对这些患者进行斗篷野及腹主动脉旁-脾蒂区照射。鉴于广泛纵隔病变患者复发率较高，我们现在除了进行斗篷野及腹主动脉旁照射外，还对这一亚组患者采用MOPP化疗。
